Parity Protection a Key Tenet of Biden Behavioral Healthcare Plan

Over the past month, I have presented commentaries on the overall behavioral healthcare plan developed by President Joe Biden, as well as 2 of the plan’s components—extension of behavioral healthcare into new settings and expansion of the behavioral healthcare workforce. Today, I would like to describe the third component of this plan—extension of parity protection and guaranteed visits without copays.

First, let me offer a little background. The Wellstone and Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health and substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical coverage.

In 2014, the Affordable Care Act of 2010 (ACA) expanded this protection. New individual market and small group plans were required to cover 10 essential health benefit categories, including mental health and substance use disorder services, and also to cover them at parity with medical and surgical benefits. These provisions also extended to the Medicaid benefits offered through the ACA state Medicaid expansions, which are gradually being implemented in most states.

Today, while most large group plans and most small group plans include coverage for some mental health and substance use disorder services, gaps remain in coverage, and many people with some coverage do not currently receive the benefit of federal parity protections. Further, parity protection has not been extended to Medicare or traditional Medicaid.

Although comprehensive federal statistics are not currently available on the number of Americans with parity protection, it is feasible to offer some approximations. More than 260 million Americans are at least 18 years old. Of these, the following groups currently do not have parity protection:

• 54.1 million adults ages 65 and over who are covered by Medicare
• 40 million adults ages 18 to 64 with coverage through traditional Medicaid
• 28.3 million adults ages 18-64 who do not have health insurance coverage at all

Thus, of the 260 million adults ages 18 and older, at least 122.4 million (47%) do not have parity protection. Further, an unknown number who do have current health insurance either lack parity protection entirely or actually are not receiving the benefits of this protection.

Biden proposes to address the lack of parity protection through the following actions in the administration’s fiscal year 2023 (FY2023) budget:

• Medicare: Extend parity protection to the Medicare program ($2.5 billion over 10 years). Further, he proposes to expand Medicare mental healthcare coverage and make access more affordable by modernizing fee-for-service mental health benefits, covering 3 behavioral health visits per year without cost-sharing, revising the criteria for psychiatric hospital terminations, and eliminating the 190-day inpatient psychiatric hospitalization lifetime limit.
• Medicaid: Improve Medicaid mental health access ($36.4 billion over 10 years). This would be accomplished by increasing access to providers, expanding community behavioral health services to improve access, establishing a performance fund to improve behavioral health, and requiring utilization of clinically appropriate criteria for Medicaid covered behavioral health services.
• Private insurance: Implement parity protection ($51.2 billion over 10 years). The president’s effort will include a demand that insurers offer an adequate network of behavioral healthcare providers, 3 visits for each client each year without cost sharing, and a request that Congress enforce parity through the introduction of civil penalties.
• Enforcement of parity: Require federal technical assistance to the states to enforce parity ($125 million in FY23).

The president has presented a very comprehensive plan to implement and enforce parity across all types of health insurance, both public and private. The proposed new federal expenditures to accomplish this essential work are in excess of $90 billion over the FY23-FY32 10-year period.

Now that the president has taken this unprecedented step, our advocacy will be essential to bring these elements across the Congressional finish line. All of us will need to engage in unprecedented advocacy to make this happen. I hope that I have convinced you about the gravity and essence of this task.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.